Heart of the Matter

Abstract

A large cardiac surgery center is planning an audit of blood product usage and wastage. Basics of audit planning are outlined. Emphasis is placed on platelets and plasma usage in conjunction with the use of cardiopulmonary bypass. Monitoring of hemostatic parameters in theaters is greatly facilitated by the adoption of viscoelastic clot tests. Causes of intra- and postoperative bleeding, including heparin overdose and platelet dysfunction, are discussed, as well as the timing of antiplatelet drug discontinuation. Despite red cell anatomical and biochemical changes during storage, age of transfused red cells does not seem to influence the mortality rates and organ dysfunction scores.